Basic Information
| Provider Information | |||||||||
| NPI: | 1285286765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISSNER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, APRN, NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 N VAN DORN ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223041920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173075268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 282 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 09/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0005X | 8465 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
No ID Information.